IV starts and drawing blood

Specialties Emergency

Published

Hi, ER nurses-

Just a question for you....what does your hospital do if a patient needs an IV start and also needs blood drawn?

Do you initiate an IV and then draw blood from another vein? Or how does this work, exactly? How have you found works best?

I am not certain how to do this.

Thanks!

SRKnurse

I like 20's too, much easier for the patient...but not when I am drawing due to the breakup of the red blood cells...

Have you ever had trouble from the lab with complaints regarding the quality of the blood?

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underwatergirl, I've routinely used 22s to draw blood and have not had a hemolysis problem. Heck, with a couple of people, I've used 24s, no problem. Use a smaller syringe and pedi tubes.

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That is cool you have no problems...just something I learned a long time ago...most blood samples...the red blood cells are broken up/apart for the test to be run.

However I think I am going to do some further research on that matter and also which test require whole red blood cells.

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Specializes in MICU.

"most blood samples...the red blood cells are broken up/apart for the test to be run."

the only time the red cells are "broken up/apart" is when you hemolyze the sample while collecting it. i take that back - if you have a patient who has drowned, due to the difference in osmolarities (water vs. body), their cells will swell and burst yielding hemolysis which is not due to collection error.

now, the lab will "centrifuge" the samples and "separate" the plasma (anticoagulant tube) or serum (sst or sterile tube with no additive) in order to run certain tests. this takes about 5-10 minutes and hence the longer turn around time for these tests.

"however i think i am going to do some further research on that matter and also which test require whole red blood cells."

cbc, hgba1c, bnp, esr, mono, sickle cell screen, t&s, aborh, crossmatches = whole blood

chemistry tests, cardiac enzymes, bhcg, any antibody test = serum or plasma

coagulation = plasma (citrate plasma = blue tube)

hope that clarifies

lifelongstudent

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"most blood samples...the red blood cells are broken up/apart for the test to be run."

the only time the red cells are "broken up/apart" is when you hemolyze the sample while collecting it. i take that back - if you have a patient who has drowned, due to the difference in osmolarities (water vs. body), their cells will swell and burst yielding hemolysis which is not due to collection error.

now, the lab will "centrifuge" the samples and "separate" the plasma (anticoagulant tube) or serum (sst or sterile tube with no additive) in order to run certain tests. this takes about 5-10 minutes and hence the longer turn around time for these tests.

"however i think i am going to do some further research on that matter and also which test require whole red blood cells."

cbc, hgba1c, bnp, esr, mono, sickle cell screen, t&s, aborh, crossmatches = whole blood

chemistry tests, cardiac enzymes, bhcg, any antibody test = serum or plasma

coagulation = plasma (citrate plasma = blue tube)

hope that clarifies

lifelongstudent

thanks babe :)

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There are a variety of reasons a sample can be hemolyzed.

You can use too much pressure in pulling the plunger while drawing the blood too quickly. You can shake the tubes too hard. Dropping the tubes...we got a whole list from our lab. Hemolysis can be caused by mishandling in the lab as well.

But if you're careful, you can use small caths and needles. Afterall, I don't think most preemies get an 18g.

Granted, an 18g is preferred for a lot of reasons, but it's not always necessary.

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Specializes in ER.
Just a note to draw blood from an IV site you need an 18 gauge for the IV or you will break up the red blood cells...which matters for most lab test. I think it is always best to go with less sticks...however....

If you notice small viens or a hard stick and want to use a smaller gauge...20 gauge...then I say do it and then draw blood on the other arm...because if it appears difficult, you may have troulbe getting a vien and sticking them more than once.

Follow your policy and procedures and use your best judgement on individual basis. In the long run I actually prefer two sticks...one for the IV on for the blood draw...but hey that is my opinion and I rarely follow it, mostly do when I know I got alot of labs/tubes for blood draws coming out...don't want to loose the IV site....

Anyway hope this helps!

Annette

not 100% accurate...Our standard for adults is 18 or 20, but I have had to put 24 g in chronic heroin users and sent all bloods off without any problems and not hemolyzed...Also, If I tried to put an 18 in a 2 month old septic work up, I'd be looking for another job...Good rule of thumb, if you really have to work at it, it probably will hemolyze the specimen and be no good or possibly cause false results...There have certainly been studies that hemolysis is less frequently occuring with larger gauge needles...

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When I made that statement I was not referring to peds...only adult population. I know the difference with peds...again my own way of dealing with the two situations.Also I stated judgement comes into play...regarding hemolyze the blood samples, that is just what I was cautioned about. Purhaps a way of ruling on the side of caution. Again individual facility policy and nursing judgement.

annette

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I work as a phlebotomist for a clinical laboratory while in nursing school. I stick about forty LTC facility residents per day, five days a week. Many geriatric patients must be stuck in the hand. They arms are often stiff due to arthritis, etc, so they are unable to extend the arm. I ONLY carry 23g butterflies for the hand stick. I might have one hemolyzed specimen per week, max. If it's an easy stick, you should never have a hemolyzed specimen using a 23. The red cells "break" when the stick is next to impossible. But a hemolyzed specimen only affects chemistry tests, such as K, Mg, Lytes, etc. Med level results like Digoxin, for example, are not affected by a hemolyzed specimen.

Another potential problem with hard sticks is clotting in the tube. It doesn't matter in a serum separater tube (SST), but I'm notorious for clotting purple tops (EDTA). Grrrrrrr......

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Specializes in ER, PACU, OR.

We start the cap, take the blood, then start the IV.

If it requires blood cultures, we do the same thing, but the second set of cultures gets drawn 20 minutes later, prefferebly from the opposite arm.

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There have been numerous articles written and published in nursing and laboratory journals on the reasons blood shouldn't be drawn when starting IV's. Hemolysis is likely even when using larger gauges, it has to do with the angiocath collapsing when suction is applied. In our facility a lengthy study was done, and with the amount of specimens that were having to be redrawn, it was actually taking more time than just letting the phlebotomist or nurse draw with a needle the first time.

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When I worked as a phlebotomist doing nursing home collections, almost all we would use were the 23g butterflies, and we rarely had hemolyzed specimens... I would use a small syringe and try to carefully control the pull on the vein.

Is it difficult to keep the catheter in place while drawing the blood? I haven't done via an IV catheter, but to me it seems like it would be easy to pull it out of the vein.

abmsam I know exactly what you mean about the lav tubes clotting - it frustrated the heck outta me!!! :chuckle

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